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Coronavirus Disease 2019-Associated Pulmonary Aspergillosis in Mechanically Ventilated Patients.
Permpalung, Nitipong; Chiang, Teresa Po-Yu; Massie, Allan B; Zhang, Sean X; Avery, Robin K; Nematollahi, Saman; Ostrander, Darin; Segev, Dorry L; Marr, Kieren A.
  • Permpalung N; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Chiang TP; Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
  • Massie AB; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Zhang SX; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Avery RK; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
  • Nematollahi S; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Ostrander D; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Segev DL; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Marr KA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Clin Infect Dis ; 74(1): 83-91, 2022 01 07.
Artículo en Inglés | MEDLINE | ID: covidwho-1621573
ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) occurs in critically ill patients with COVID-19. Risks and outcomes remain poorly understood.

METHODS:

A retrospective cohort study of mechanically ventilated adult patients with COVID-19 admitted to 5 Johns Hopkins hospitals was conducted between March and August 2020. CAPA was defined using composite clinical criteria. Fine and Gray competing risks regression was used to analyze clinical outcomes and, multilevel mixed-effects ordinal logistic regression was used to compare longitudinal disease severity scores.

RESULTS:

In the cohort of 396 people, 39 met criteria for CAPA. Patients with CAPA were more likely than those without CAPA to have underlying pulmonary vascular disease (41% vs 21.6%, respectively; P = .01), liver disease (35.9% vs 18.2%; P = .02), coagulopathy (51.3% vs 33.1%; P = .03), solid tumors (25.6% vs 10.9%; P = .02), multiple myeloma (5.1% vs 0.3%; P = .03), and corticosteroid exposure during the index admission (66.7% vs 42.6%; P = .005), and had lower body mass indexes (median, 26.6 vs 29.9 [calculated as weight in kilograms divided by height in meters squared]; P = .04). Patients with CAPA had worse outcomes, as measured by ordinal severity of disease scores, requiring longer time to improvement (adjusted odds ratio, 1.081.091.1; P < .001), and advancing in severity almost twice as quickly (subhazard ratio, 1.31.82.5; P < .001). They were intubated twice as long as those without CAPA (subhazard ratio, 0.40.50.6; P < .001) and had longer hospital stays (median [interquartile range], 41.1 [20.5-72.4) vs 18.5 [10.7-31.8] days; P < .001).

CONCLUSION:

CAPA is associated with poor outcomes. Attention to preventive measures (screening and/or prophylaxis) is warranted in people with high risk of CAPA.
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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Aspergilosis Pulmonar / Aspergilosis Pulmonar Invasiva / COVID-19 Tipo de estudio: Estudio de cohorte / Estudios diagnósticos / Estudio observacional / Estudio pronóstico Tópicos: Covid persistente Límite: Adulto / Humanos Idioma: Inglés Revista: Clin Infect Dis Asunto de la revista: Enfermedades Transmisibles Año: 2022 Tipo del documento: Artículo País de afiliación: Cid

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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Aspergilosis Pulmonar / Aspergilosis Pulmonar Invasiva / COVID-19 Tipo de estudio: Estudio de cohorte / Estudios diagnósticos / Estudio observacional / Estudio pronóstico Tópicos: Covid persistente Límite: Adulto / Humanos Idioma: Inglés Revista: Clin Infect Dis Asunto de la revista: Enfermedades Transmisibles Año: 2022 Tipo del documento: Artículo País de afiliación: Cid